Swimming with the trend: Angela Wilkes looks at the controversy surrounding birth under water

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The Independent Online
IS THE fashion for giving birth under water a dangerous affectation, a trend that has gone too far? Are New Age fantasies about rekindling our kinship with whales putting babies at risk of drowning? Or is a mother-to-be's desire to sink into warm water an instinctive form of pain relief, a sensible practice which ushers a child gently from one natural environment into another and carries no higher risk than any other form of childbirth?

This week's stories of stillborn children in Britain and Sweden, of lungs fatally filled with fluid and survivors suffering possible brain damage seems to indicate a time for stocktaking and caution. The Royal College of Obstetricians and Gynaecologists has written to the Department of Health, asking for more research into the safety of this method. Professionals are clearly wondering if the fashion has got out of hand. Midwives have been anxiously telephoning the college for advice. Pregnant women are probably cancelling birth pool bookings in droves.

In fact, a national survey into the extent and safety of water birth began in June. It is being carried out by the National Perinatal Epidemiological Unit at the John Radcliffe Hospital in Oxford and should produce preliminary results in a year's time. The impetus for the research came from the all- party Commons health committee, which recommended in 1991 that all hospitals should make birthing pools available. According to Mary Renfrew of the John Radcliffe perinatal unit, this radical suggestion provoked unease. 'Our unit became concerned because we were getting calls from midwives, the National Childbirth Trust, obstetricians and women themselves wanting to know about the safety of this practice. There had been plenty of case studies of women labouring in water. We looked at them worldwide and found none with serious adverse consequences. But there were no scientifically controlled trials on women giving birth in water.'

But there is a problem. Research into the effectiveness and safety of water birth may simply not be capable of proper evaluation. It would require the participation of thousands of women. They would have to be willing, for the sake of random control trials, to go into labour without knowing whether they were going to have a conventional delivery or a water birth. Research would have to be worldwide and after all that interpretation may prove impossible. Britain's national stillbirth rate is already around 4.3 per thousand. How can researchers know whether a baby who died during a water delivery would not have died during a 'conventional' delivery?

An important fact overlooked in last week's furore is that the method was not developed as a way of giving birth - only of relieving pain during labour. Michel Odent, a French obstetrician, pioneered the use of warm pools in the 1970s and continues to be an enthusiastic advocate for their use as pain relievers. The 'magic' of water, according to Odent, is not new. 'Women have always been attracted to it, and giving birth in or near water goes back centuries in all sorts of cultures. There are pictures from Africa, stories from south Japan of sea births and, of course, myths such as the birth of Venus.'

Odent suggests that the success of water birthing ties in with the theory first postulated by Sir Alistair Hardy at Oxford and popularised by Elaine Morgan in her book, Aquatic Ape. In essence this says that human beings are primates especially adapted to life at the ocean's edge. 'From what we know about the nutritional needs of developing human brain, it seems to require a range of fatty acids which is abundant only in the seafood chain.' Babies up to the age of five months possess primitive reflexes, too, which make them natural underwater swimmers, able instinctively to resist inhaling water.

The idea for birthing pools first came to Odent while he was working at a hospital in Pithiviers near Paris. 'So many women in labour wanted a shower or bath that they went round to the garden centre and bought a small child's plastic paddling pool. Until 1985, ours was the only hospital in the world where a pool was available. We tended to use it only for women in the first stages of a long, difficult labour, when they had back pain, as a way of avoiding drugs and their side effects.' Underwater births happened accidentally sometimes. 'I was very cautious about it then. I pointed out in an article in the Lancet that it was important for midwives and doctors to know that this was a possibility. Now it's different. Centres in Belgium and California have delivered 1,000 babies under water. We can see that, in the hands of experienced people using water in a wise way, bringing the baby to the surface right away, it does not constitute a danger.'

However, in the hands of some Californian fanatics, the process may have got out of hand. Babies were deliberately held under water after being delivered, Odent says, in the belief that this was a 'gentle' introduction to the world. Is the controversy over water birthing 'medical' at all - or is it another version of the political divide that has characterised arguments over childbirth since the rise of feminism? According to some, childbirth has become a power struggle. In one corner are the women - midwives seeking greater professional recognition, pregnant women demanding 'empowerment' and choice. In the other corner is the predominantly male medical establishment, seeking control over birth with high technology. Birth pools enter this conflict because, as Sheila Kitzinger, author of Freedom of Choice in Childbirth, points out, you can't do much hi-tech intervening on a woman who's up to her armpits in warm water.

There may be another, more up-to-date 'hidden agenda'. Doctors live in fear of potentially ruinous litigation from procedures that go wrong and they are increasingly concerned about the unknown aspects of water birth. This is not to say that the controversy does not stem from a genuine concern. But in an age when all babies are expected to live - however unrealistic this expectation may be - the cost of a baby's death is no longer measured solely in tears.

(Photograph omitted)